Development, reliability, and validity of the mobility assessment scale in hospitalized patients (HMob).

BACKGROUND: Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE: Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS: The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION: The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.

Brazilian Government Strategies to Protect Women.

In 2018, 22,000,000 Brazilian women experienced some type of violence (either physical or psychological), and 42% of these episodes occurred in the domestic environment. Therefore, government strategies have been developed to solve this problem. This study aimed to (a) carry out a survey of Brazilian government strategies for the protection of women after the creation of the Maria da Penha Law (Law No. 11.340, 2006) and (b) discuss these strategies from the concept of cultural design. Sixteen laws, five decrees, and two ordinances were found and analyzed. In a general way, the analysis suggests that they are not effective cultural plans because most do not show long-term results, and some of the laws that typify crimes and those that relate to the aggressor's behavior do not specify the target behaviors, so there is no explicit contingency. Despite this, such strategies are relevant, as they end up providing the protective context for women from a social, legal, and political point of view. Finally, it is expected that the discussions raised in the present work can help prepare interventions that favor socially beneficial cultural practices.

Effectiveness of rhBMP-2 association to autogenous, allogeneic, and heterologous bone grafts.

Proteins with osteoinductive potential, especially recombinant human bone morphogenetic protein (rhBMP)-2, have large effects on cell growth and their differentiation. The aim of this study was to assess repair of bone defects in rat calvaria with different types of grafts associated with rhBMP-2, through immunohistochemistry and micro computed tomography (CT) analyses. A total of 35 male Wistar rats were selected, each weighing ~250 g, with a waiting period of 6 weeks from the creation of the defect to the sacrifice, and divided into five groups (n = 7): autograft plus 5 µg rhBMP-2 (AuG/BMP-2); allograft plus 5 µg rhBMP-2 (AlG/BMP-2); xenograft (heterologous) plus 5 µg rhBMP-2 (XeG/BMP-2); 5 µg rhBMP-2 (BMP-2) and the control group (n = 7). The micro CT reveal that all groups associating different bone grafts with BMP-2 showed increased bone formation compared to the control. The immunostaining show that osteocalcin and bone sialoprotein were higher in groups with BMP-2 than control group; BMP was high expressed in AuG/BMP-2, AlG/BMP-2, and BMP-2; vascular endothelial growth factor (VEGF) was more expressed in groups with BMP-2; VEGF-R2 was low to moderate in AuG/BMP-2, XeG/BMP-2, and BMP-2, predominantly moderate in AlG/BMP-2 and low in the control; CD-31 was predominantly moderate in AuG/BMP-2, AlG/BMP-2, and XeG/BMP-2, low to moderate in BMP-2 and low in the control. The results revealed that rhBMP-2 improved bone repair when administered alone, or when associated with different bone grafts.

MMPs are Involved in Osteoporosis and are Correlated with Cardiovascular Diseases.

Osteoporosis and cardiovascular diseases are common causes of morbidity and mortality worldwide, especially in people aged over 60 years. Osteoporosis is characterized by low bone mineral density, which deteriorates the microarchitecture of bones and increases the risk of bone fractures. Other pathologies also constitute risk factors for the development of osteoporosis, mainly cardiovascular diseases. In fact, a growing number of reports have shown a positive correlation between cardiovascular diseases and low bone mineral density. MMPs are proteases that participate in the organized degradation of the extracellular matrix (ECM) and which play essential physiological roles, such as cardiovascular and bone tissue remodeling. Overexpression of MMPs underlies pathological processes like osteoporosis and cardiovascular diseases. MMP-1, -2, -9, -13, and -14 are expressed in bone tissue and are key players in the digestion of bone matrix by osteoblasts. Considering this relationship between osteometabolic and cardiovascular pathologies and MMPs, this review focuses on the involvement of MMPs in osteoporosis and on their participation in cardiovascular diseases; it also deals with the positive correlation between osteoporosis and cardiovascular diseases. Although there are many drugs to treat osteoporosis, controversies exist. Here, we will describe these controversies and will discuss how inhibition of MMPs could be an alternative strategy to or an adjuvant therapy in the current treatment of osteoporosis.

Influence of parenteral nutrition delivery system on the development of bloodstream infections in critically ill patients: an international, multicenter, prospective, open-label, controlled study--EPICOS study.

BACKGROUND: Parenteral nutrition (PN) is associated with an increased risk of developing bloodstream infections (BSIs) but the impact of the PN delivery system upon BSI rates remains unclear. This was an international, multicenter, prospective, randomized, open-label, controlled trial that investigated the differences of BSIs associated with 2 different PN systems. METHODS: Patients were randomly allocated in a 2:1:1 ratio to receive either PN delivered by a multichamber bag (MCB group), or by compounded PN made with olive oil (COM1 group) or with MCT/LCT (COM2 group). Blood cultures were performed to evaluate the incidence of BSIs, and catheter use data was collected to calculate CLAB and central venous catheter device use ratio (CVC-DUR). Secondary outcomes included the development of severe sepsis/septic shock, number of intensive care unit (ICU) and hospital days, and all-cause mortality at Day 28. RESULTS: 406 patients were included: 202 in the MCB group, 103 in the COM1 group, and 101 in the COM2 group. Baseline characteristics were well balanced between the 3 groups, BSIs were significantly higher in patients receiving compounded PN (46 BSIs for COM1+COM2 vs 34 BSIs for MCB; p = 0.03).CLAB was higher in patients receiving compounded PN (13.2 for COM1+COM2 vs 10.3 for MCB; p < 0.0001). No differences were observed for the secondary outcomes. CONCLUSION: Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN. TRIAL REGISTRATION NUMBER: NCT00798681.

Development of an aspheric 22-diopter 50-mm diameter magnifier.

PURPOSE: To develop in an interdisciplinary approach between ophthalmology and design areas an ergonomic +22-diopter 50-mm aspheric hand magnifier for low vision. METHODS: An aluminum cylinder was cut, processed using a lathe and carved to produce a ring that accommodated a 50-mm aspheric lens, with an external depression not to slide from the holder's fingers. A cylindrical steel bar was cut, processed using a lathe and carved in order to form an externally turned ring to be screwed into the internal thread of the aluminum ring, to maintain the lens in a steady position. Both rings were submitted to electrostatic painting with a dull black electrostatic Epoxi ink, except the lower border of the external ring, to indicate the correct side of the magnifier to face the material to be read. RESULTS: A 22-diopter 50-mm diameter aspheric lens magnifier with a black ring to be hold at its external circular depression was obtained in order to safely search the adequate reading focus with an inferior aluminum colored ring to face the object to be read and allow a less distorted reading. This is the first Brazilian high-magnification great-diameter magnifier for low vision that permits basically the focusing on an entire word, not only syllables, in order to allow a faster and more comfortable reading. CONCLUSIONS: By an interdisciplinary approach a 22-diopter 50-mm aspheric lens magnifier was developed with image and ergonomic characteristics such as to permit comfortable and adequate reading performance in cases of low vision.

Quantification and molecular characterization of Salmonella isolated from food samples involved in salmonellosis outbreaks in Rio Grande do Sul, Brazil.

Data concerning the prevalence and populations of Salmonella in foods implicated in outbreaks may be important to the development of quantitative microbial risk assessments of individual food products. In this sense, the objective of the present study was to assess the amount of Salmonella sp. in different foods implicated in foodborne outbreaks in Rio Grande do Sul occurred in 2005 and to characterize the isolated strains using phenotypic and genotypic methods. Nineteen food samples involved in ten foodborne outbreaks occurred in 2005, and positive on Salmonella isolation at the Central Laboratory of the Health Department of the State of Rio Grande do Sul, were included in this study. Food samples were submitted to estimation of Salmonella using the Most Probable Number (MPN) technique. Moreover, one confirmed Salmonella colony of each food sample was serotyped, characterized by its XbaI-macrorestriction profile, and submitted to antimicrobial resistance testing. Foods containing eggs, mayonnaise or chicken were contaminated with Salmonella in eight outbreaks. Higher counts (>10(7) MPN.g(-1)) of Salmonella were detected mostly in foods containing mayonnaise. The isolation of Salmonella from multiple food items in five outbreaks probably resulted from the cross-contamination, and the high Salmonella counts detected in almost all analyzed samples probably resulted from storing in inadequate temperature. All strains were identified as S. Enteritidis, and presented a unique macrorestriction profile, demonstrating the predominance of one clonal group in foods involved in the salmonellosis outbreaks. A low frequency of antimicrobial resistant S. Enteritidis strains was observed and nalidixic acid was the only resistance marker detected.